Is Bundled Payment the Biggest Opportunity for Orthopedics?

At the 12th Annual Spine, Orthopedic and Pain Management-Driven Conference in Chicago on June 13, Laura Miller, editor in chief of Becker’s Spine Review, facilitated a panel discussion on the future of orthopedics.

After asking the panelists what they see as the biggest opportunity for orthopedics today, the conversation turned quickly to bundled payments. Under a bundled payment, a provider receives a single payment for an entire episode of care. For orthopedics this might include all services three days prior to a surgery to 30 or 60 days after; the physician fee, facility fee, anesthesia, imaging and PT are all included in the single, bundled payment.

“Bundled payments are a great opportunity for surgeons,” said Matt Pate, senior vice president of the physician strategy group at United Surgical Partners International.

Michael J. McCaslin, CPA, principal at Somerset CPAs, said “huge opportunities” exist for surgeons willing to take on bundled risk, but first they must “control the assets that enable you to take risk.” For orthopedic surgeons, this means having ownership of or partnerships with imaging, a surgery center and physical therapy.

“The future is making money on the money left over from managing risk, not from being a surgeon [in the traditional sense],” said Mr. McCaslin. “It’s embracing a change in culture that says, we’re more than surgeons, we’re care managers.”

The key to success in accepting the risk inherent in bundled payment is to understand your costs, both for patients inside and outside the clinic, said Mr. Pate. Understanding costs, as well as outcomes, in additional to a relationship with all the various sites of care along the orthopedic care continuum will be key to success in bundled payment.